CTICasesLeft Atrial Myxoma with Variable Appearance on MRI
Imaging findings
An initial abdomen and pelvis CT corner shot from 2015 identified a 1.6 cm pedunculated, low-attenuation lesion in the region of the interatrial septum, thought to be a thrombus. A follow-up cardiac MRI about a month later showed a much smaller lesion, less than 1 cm, and was poorly visible on some sequences (e.g., black blood), suggesting possible shrinkage. A repeat MRI six months later showed the lesion to be readily apparent again, appearing almost identical in size to the original CT, despite the patient being on anticoagulation throughout. Surgical resection confirmed a 1.6 cm myxoma with no associated thrombus.
Key takeaways
Myxomas can be challenging to visualize consistently on all MRI sequences, particularly on steady-state free precession (SSFP) images, or may be missed due to slice thickness and gaps in acquisition. Apparent shrinkage on imaging, even with anticoagulation, should be interpreted cautiously as it may represent imaging limitations rather than true resolution. Behavior atypical for thrombus (e.g., lack of complete resolution on anticoagulation or recurrence) should raise suspicion for a myxoma, prompting surgical intervention.
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